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Pain After PCNL Surgery: What Is Normal?

Pain After PCNL Surgery: What Is Normal?

📖 7 min read Written/reviewed by Dr. Alhad Naragude, MBBS, MS, DrNB Urology Last updated: June 27, 2026

Pain after PCNL surgery is usually felt as dull pain, soreness or heaviness in the back or side where the kidney was accessed. Mild burning while passing urine, light blood in urine, bladder irritation and DJ stent discomfort can also be normal during recovery. These symptoms should gradually improve. Severe pain, fever, chills, heavy bleeding, inability to pass urine, dizziness, pus from the wound or breathlessness are not normal and need urgent medical care.

PCNL is minimally invasive, but it is still a major kidney stone surgery. Some discomfort is expected. Worsening pain is not.

Pain after PCNL surgery: what is normal?

PCNL, or percutaneous nephrolithotomy, is a procedure used to remove large or complex kidney stones through a small cut in the back. EAU Patient Information describes PCNL as a treatment for large or complex stones, and BAUS patient information explains that a bladder catheter, ureteric stent or nephrostomy tube may be used depending on the operation.

Normal vs worrying pain after PCNL

Symptom Usually normal if… Worry if…
Back/flank pain Mild to moderate and improving Severe, increasing or not relieved by medicines
Wound pain Mild tenderness near dressing or tube site Redness, pus, swelling or foul smell
Blood in urine Pink or light red urine, gradually clearing Heavy bleeding, clots, dizziness or weakness
Burning urination Mild and improving Fever, severe burning or foul-smelling urine
DJ stent discomfort Frequency, urgency or mild pain while urinating Severe pain, fever or inability to pass urine
Nephrostomy site leakage Mild leakage for a short time after tube removal Persistent leakage, fever or worsening pain

Why does pain happen after PCNL?

Kidney access tract pain

During PCNL, a small passage is created from the skin into the kidney. This allows the surgeon to break and remove the stone. Because skin, muscle and kidney tissue are involved, pain while turning in bed, coughing, standing up or walking can happen for a few days.

Nephrostomy tube pain

A nephrostomy tube is a temporary tube coming out through the back to drain urine from the kidney. It can cause pulling, heaviness or discomfort at the tube site. Mild leakage after tube removal may happen, but persistent leakage, fever or increasing pain needs review.

DJ stent pain

A DJ stent is a thin internal tube between the kidney and bladder. It helps urine drain while swelling settles. It can cause frequent urination, urgency, burning, lower abdominal discomfort and back pain while passing urine.

Bladder catheter irritation

A urinary catheter may be kept for a short time after PCNL. It can cause bladder spasms, burning or a feeling that you need to pass urine. This usually improves after catheter removal.

What is normal after discharge?

After going home, many patients still feel weak or sore for a few days. This does not always mean something is wrong.

It can be normal to have:

  • Mild back pain near the PCNL wound.
  • Tiredness while walking or climbing stairs.
  • Mild burning while passing urine.
  • Pink urine on and off.
  • More blood in urine after extra walking.
  • Stent-related frequency or urgency.
  • Mild discomfort while changing position.

These symptoms should reduce with rest, fluids and prescribed medicines. They should not become progressively worse.

PCNL recovery timeline

First 24-48 hours

Pain is usually highest in the first one to two days. You may have a catheter, dressing, nephrostomy tube or DJ stent. Mild blood in urine is common. The hospital team monitors pain, fever, urine output, bleeding and kidney function.

Days 3-7

Back pain should start reducing. Walking usually becomes easier. Burning urination, tiredness and stent discomfort may continue. Light blood in urine may increase after walking or activity, but it should settle with rest and fluids.

Weeks 2-4

Most patients feel much better by this stage. Mild tiredness or stent-related symptoms can continue until the DJ stent is removed. Cleveland Clinic notes that recovery after PCNL commonly takes about two to four weeks, although recovery varies depending on stone size, infection, bleeding, number of punctures and general health.

What pain is not normal after PCNL?

Call your urologist urgently if you have:

  • Pain that is not improving after a few days.
  • Burning urination that is worsening.
  • Blood in urine that keeps increasing.
  • Stent pain affecting sleep or daily activity.
  • Urine leakage from the wound.
  • Doubt about catheter, stent or nephrostomy tube care.
  • No clear DJ stent removal date.

Go to emergency care if you have:

  • Severe pain not relieved by prescribed medicines.
  • Fever, chills or shivering.
  • Heavy blood in urine or large clots.
  • Inability to pass urine.
  • Persistent vomiting.
  • Dizziness, fainting or marked weakness.
  • Pus, foul smell or increasing redness at the wound.
  • Breathlessness, chest pain or severe shoulder pain.
  • Confusion, very low urine output or fast heartbeat.

BAUS specifically advises urgent medical contact after PCNL for fever, kidney-area pain, severe pain while passing urine, inability to pass urine or worsening bleeding. EAU guidelines also emphasise urgent action when infection or sepsis is suspected in stone disease.

How to reduce pain after PCNL surgery at home

Take medicines exactly as prescribed

Use only the painkillers, antibiotics, bladder medicines or stent medicines prescribed by your urologist. Avoid taking extra painkillers, blood thinners or leftover antibiotics without medical advice.

Drink fluids as advised

Good hydration helps keep urine flowing and may reduce clot formation. But if you have kidney disease, heart disease or fluid restriction, follow your doctor’s specific advice.

Walk gently

Short walks are helpful. Avoid heavy lifting, gym workouts, cycling, running, sudden bending and long travel until your urologist clears you.

Keep the wound clean and dry

Change the dressing as advised. Do not apply powders, oils, turmeric, antiseptic creams or home remedies unless your doctor has recommended them.

Do not miss DJ stent removal

A DJ stent is temporary. The removal date depends on swelling, infection risk, bleeding, residual stones and your surgeon’s plan. A forgotten stent can cause infection, stone formation and kidney problems.

Why do I get back pain while passing urine after PCNL?

Back pain while passing urine is commonly due to the DJ stent. During urination, bladder pressure can travel upward through the stent toward the kidney, causing a brief flank ache.

This is usually not dangerous if it is mild and temporary. But severe pain, fever, chills, foul-smelling urine or inability to pass urine needs evaluation.

What will the urologist check if pain continues?

If pain after PCNL surgery is not improving, your urologist may check for:

  • Urine infection.
  • Blood clots in urine.
  • Blocked DJ stent.
  • Residual stone fragments.
  • Collection or urine leak around the kidney.
  • Wound infection.
  • Kidney function changes.

Tests may include urine routine, urine culture, CBC, serum creatinine, ultrasound KUB, X-ray KUB or CT KUB depending on symptoms. NICE guidance on renal and ureteric stones focuses on assessment, stone clearance and prevention of recurrence, which are important parts of follow-up after stone treatment.

What to bring for consultation after PCNL

Bring:

  • PCNL discharge summary.
  • Operative notes, if available.
  • USG KUB, X-ray KUB or CT KUB reports.
  • Urine routine and urine culture reports.
  • Serum creatinine and CBC reports.
  • Stone analysis report, if available.
  • Current medicines.
  • DJ stent card or stent removal date.
  • Details of catheter or nephrostomy tube, if present.
  • Photos of wound leakage or redness, if relevant.

FAQs

Is pain after PCNL surgery normal?

Yes. Mild to moderate back pain, wound soreness, DJ stent discomfort and burning urination can be normal after PCNL surgery. The pain should gradually improve.

How many days does pain last after PCNL?

Pain is usually more noticeable for the first few days and improves over one to two weeks. Mild discomfort or stent symptoms may continue until the DJ stent is removed.

Is blood in urine normal after PCNL?

Light blood or pink urine can be normal after PCNL. Heavy bleeding, large clots, dizziness or inability to pass urine is not normal and needs urgent care.

Why do I get back pain while passing urine after PCNL?

This is commonly due to the DJ stent. Bladder pressure during urination can travel upward toward the kidney and cause temporary flank pain.

Is fever normal after PCNL?

No. Fever, chills or shivering after PCNL may suggest infection and should be reported urgently.

Can I sleep on the side after PCNL?

You may sleep in a comfortable position unless your surgeon has given specific restrictions. Avoid putting pressure on a nephrostomy tube or painful wound area.

When can I return to work after PCNL?

Many patients return to light work in one to two weeks. Heavy work, travel and exercise may need more time depending on recovery, bleeding risk, stent status and your surgeon’s advice.

When is the DJ stent removed after PCNL?

The timing varies. It depends on stone burden, swelling, infection, bleeding and the surgeon’s plan. Always confirm your stent removal date before or soon after discharge.

Related reading

References

Note: This information is for educational purposes only and is not a substitute for medical advice. Please consult your doctor for any symptoms.